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PSA and the Detection of Prostate Cancer

Anthony S. Robbins, MD, MPH
JAMA. 1994;271(3):192. doi:10.1001/jama.1994.03510270038022.
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To the Editor.  —Catalona et al1 express proper caution regarding the value of prostate-specific antigen (PSA) screening in the general population, noting that its benefits in reducing mortality have not been established. However, their findings can actually be used to estimate the possible adverse mortality associated with PSA screening and its sequelae among men 75 years of age and older.Recently, Fleming et al2 demonstrated by use of decision analysis that, compared with watchful waiting, radical prostatectomy in men 70 years of age and older with localized prostate cancer not only lacks treatment superiority, but generally appears to be harmful. This is due to two facts: first, it has yet to be demonstrated that among clinically localized cases, mortality from prostate cancer is reduced after radical prostatectomy compared with mortality among cases not treated surgically; and second, in men 75 years of age and older, the 30-day postoperative


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